Provider Demographics
NPI:1982197141
Name:ANGELCARE WITH VISION
Entity Type:Organization
Organization Name:ANGELCARE WITH VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CEASOR
Authorized Official - Suffix:
Authorized Official - Credentials:CNA,ASSITED ADMINIST
Authorized Official - Phone:850-273-3703
Mailing Address - Street 1:3577 FLAT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-3515
Mailing Address - Country:US
Mailing Address - Phone:850-273-3703
Mailing Address - Fax:850-442-4412
Practice Address - Street 1:3577 FLAT CREEK RD
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324
Practice Address - Country:US
Practice Address - Phone:850-273-3703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1006402000Medicaid
FL265-87-4225Medicaid